For some time, many solutions have been accepted to retain in a stable manner several materials: metallic, ceramic or acrylic, supported by implants (threaded or impacted) in maxillary bones. At a primary state, all of them have been accepted by the organism, but secondary causes, derived from their surgical or prothesic handling result in an excessive closeness between them (inter-implantary gap), convergence or divergence (lack of parallelism and excessive biomechanical stresses), or non anatomical deficient gingival architecture (compromise of hygiene and food packing), which have led to inflammatory problems in the peri-implantary soft tissues (periodontal) and reduction of hard tissues (bone), with the failure and final loss of said implants. Without forgetting from the aesthetic point of view, large number of failed tests to reach a visual appearance that the user never really accepts.
One of the problems most discussed, has been the morphological discrepancy existing between fixing in the bone-implant and the root of a natural tooth; most current implants have a round or cylindrical outline in their head or upper end and non-anatomical (oval, triangular), different to what occurs in natural dentures. Attempts have been made to solve this discrepancy by using healing pillars in the second surgery. First of all, the only result obtained with these pillars was an alignment of the external outline of the implant, being externalized above the gum, for connection of the definite prothesic restoration. In this period of the implanting technique, osteointegration prevailed more than the aesthetic role of restoration.
After a time, the so-called anatomically sized healing pillars appeared (Emergence Profile System), proposed by Lazzara (U.S. Pat. No. 4,856,994), likewise by Niznick (U.S. Pat. No. 4,758,161 July, 1988; E.P. no. 0669111 AZ and B.P. No. 0669111 A3 November, 1994) propose another system of healing pillars (Spectra System), and last but not least, Daftary presented the system of anatomical pillars with successive modifications (U.S. Pat. Nos. 5,035,6319 July, 1991; 5,073,111 December, 1991; 5,145,978 September, 1992; 5,213,502 May, 1993; 5,362,235 November, 1994; 5,431,507 July, 1995; FE 2070239 July, 1995).
The principle of all these pillars is based on the expansion of the peri-implantary soft tissues, creating a sufficient space to locate an artificial tooth, with the most acceptable gingival outline, but not solving the previous premise of the original healing pillars, but contributing like the previous ones a round section at a cervical level and non-anatomical (oval, triangular) as occurs in a sectional cut at this level, in the natural denture.
To solve this problem, the fixing of healing pillars has also been proposed for their intra-oral modification, permitting, according to the operators criterion their inter-proximal, occlusal and axial reduction of their walls, proposed by Sicilia (ES 2051239), or extra-oral techniques, by means of temporary restorations to create a correct morphology in the healing of the peri-implantary soft tissues, according to the neighboring contra-lateral dentition, forming a tissue guide in the sub-gingival gap where the final prothesic restoration is going to be housed.
Highlighting the modification introduced by Daftary F., with the bio-aesthetic system (Bio-aesthetic Abutment System, International Journal Dental Symposia, vol. III, n1 pp. 10-15, Steri-os Yorba Linda, Calif.), in which he informed of the attainment of a transmucosal pillar of totally anatomical shape, making the use or manufacture of other types of provisional restorations unnecessary, for the peri-implantary soft tissue guide.
To obtain an optimum tissue harmony between the prothesic restoration and the implant supporting it, we should control the emergence direction of the external head of the fixing notifying that a minimum deviation exists, as an excessive inclination towards the mouth would imply an important aesthetic compromise and if the opposite occurs towards the tongue, we will cause of problem of hygienic maintenance for the user and for this reason, it should count with a system of surgical guides controlling the parallelism and gap between the successive implants and adjacent teeth during the initial drilling of the bone in the first surgery.
Currently, a controversy exists, as a result of the appearance of the surgical aid system proposed by P. Palacci (Optimal Implant positioning and soft tissue management for Branemark System, Quitossensu Publishing Company Inc. 1995) where the method is laid down and its use-discussed (R.X. Sullivan; Nobelpharma Hoy; Vol. 5 No. 1 pp. 2, 1996) to manage that the first locations for implants adjacent to natural teeth begin exactly at 3.5 mm distance, this being considered a minimum and frequently ideal for natural dentition.
For this reason, the challenge of designing a system contributing an anatomical, biological, functional and predetermined aesthetic outline, in turn not implying restrictive handling due to its complexity for the operator, is that proposed with the system of orientation posts, healing pillars and cervico-anatomical transfer pins, with their corresponding surgical guides.